Q&A WITH THE MEDICAL DIRECTOR OF MEDWELL
Pandemics and acute emergencies raise pressing medical, ethical and organisational challenges. These include global governance, priority setting, triaging of patients, allocation of scarce resources and restricting individual liberty in the interests of public health. We will focus particularly on an issue of direct relevance to all respiratory team members, i.e. what is the duty of the healthcare workers to continue working in the face of personal risk.
1. What would you say are the advantages of being in a secluded village where all medical services are right on-site?
Answer: it is important to view Harbour Bay Village as a community with a specific culture and specific health status of members of the community. Healthcare therefore moves from encounter management (when you are sick) to proactive management of the health status of the community as a whole and individual residents specifically. So, risk is assessed periodically and addressed to try and prevent adverse events following such risks. An example would be the current COVID-19 epidemic where the most vulnerable in the whole community are identified and managed according to a specific protocol.
2. Where do you get your supplies in times such as this where the whole nation is in lock-down? Are there escalation procedures to get additional resources?
Answer: As an international and diversified company, we have our own pharmaceutical and equipment company, Edna Medical Distributors as part of the Medwell SA group. During this period of spreading of the COVID-19 infections, we were so far able to equip our clinical staff with the necessary Personal Protection Equipment and also managed to provide sanitizers and facial masks for residents in units where we provide care.
3. What protocols are followed by Medwell to enforce a national lock-down situation on-site and in the care centers?
Answer: Of importance is that the world is learning every day about the SARS-CoV-2 virus and Covid-19 infections. Treatment followed thus far may have been not appropriate given new research that is emerging daily. So, we have a team that monitor the epidemiological and clinical developments daily, and we adapt our insights into developed protocols for the prevention, identification and management of COVID-19 infections in the community.
4. How do you ensure staff safety amidst crisis? Are there assurances that you need to provide to the facility staff members so they feel safe at work?
Answer: Our work reflects a commitment towards the care of the community. In cases of an epidemic such as the COVID-19 we are currently experiencing, the care also extends to our caregivers and nurses on the frontline of care with residents and patients. Therefore, we continuously screen and train staff, provide access to prevention i.e. influenza vaccination and providing them with the Personal Protection Equipment required per identified situation.
5. If illness causes high absenteeism, are employees cross-trained and able to perform multiple duties.
Answer: Yes. Our trainers are generalists, but we do have areas where special training is involved like patients on permanent ventilation or patients requiring palliative care.
6. What infrastructure support is needed to support a shift to an at-home workforce
Answer: In the ideal world, it would have been preferable to accommodate all staff, especially those in the Frail Care Centre, for the full period of the lock-down. We had excellent cooperation with body corporates to achieve that goal in some of the retirement estates where Medwell is appointed as the service provider. On the longer-term the socio-economic impact of these arrangements become problematic but we continue to manage the situation of incoming health workers within the recommended guidelines for prevention and containment of COVID-19.
7. Will Medwell monitor, or even restrict, visitors who travelled to high-risk regions?
Answer: Medwell SA views its interaction with the Body Corporate (BC) as a partnership. We provide the evidence-based input to the BC for them to make decisions with regards to residents and other service providers. During the lockdown and even after the lockdown the access to the Village and certainly to areas regarded as high risk with a higher vulnerability of residents, we will recommend restriction of access to remain in place.
8. What procedures do you have in place to decontaminate the facility and its heating, ventilation, air-conditioning systems, electronic equipment and soft materials (blankets, curtains, etc.)?
Answer: HVAC systems are serviced and subsequently decontaminated by the applicable contractor and to a certain extent, the electronic equipment as well, as this is a specialized function that requires specialized procedures and equipment. Besides adhering to Departmental norms and standards, Medwell SA has environmental cleaning policies in place to ensure high cleanliness and hygiene standards. We also work with the on-site cleaning and catering company to ensure all laundry materials and soft furnishings are cleaned, sterilized and decontaminated as a matter of routine as per strict regulatory guidelines.
9. Is there a trained and representative crisis management team that includes on-call staff, and do those team members know what is expected of them?
Answer: The Medwell SA National COVID-19 co-ordinator directs the senior management team. For crises management we do have an emergency number and the risk team are available on request.
10. What would you say is the projected outcome for SA? Are we still to face the worst?
Answer: The COVID-19 epidemic will certainly continue to spread and impact on the lives of South Africans. If we look at trends in the rest of the world the worst is still to come. One of the variables which are still uncertain is whether the BCG-vaccination program in South Africa will afford us some respite as postulated in scientific publications.
11. How can the bigger SA implement extra precaution to avoid contracting the virus?
Answer: We believe that the approach in South Africa has been optimal. So after lockdown, the behaviour change that ordinary citizens adopted should continue to provide any measure of control.
12. What advice could you give to the elderly demographic with regards to respiratory health and exercise, to ensure that their respiratory system stays healthy?
Answer: The most important aspect is to ensure that the health status of every individual, irrespective of their age or chronic illnesses, are optimally maintained. This means the control of chronic diseases like diabetes, high blood pressure, emphysema, and heart failure. A healthy diet rich in vitamins should be maintained and getting regular exercise within the limits of each individual’s ability must be part of everyone’s daily routine. We also recommend that seasonal influenza vaccination should be administered and for those who have not had a pneumococcal vaccination within the past five years, to prevent pneumonia, to get vaccinated.